Recommended Dose of Simethicone for Colonoscopy Preparation

For colonoscopy preparation, a dose of at least 320 mg of simethicone is recommended to improve bowel preparation quality and reduce bubbles. 1

Dosing Recommendations Based on Guidelines

The US Multi-Society Task Force on Colorectal Cancer specifically recommends a dose of at least 320 mg of simethicone when used as an adjunct to bowel preparation regimens 1
Clinical trials have used various doses ranging from 200 mg to 1,200 mg with positive effects on bowel preparation quality 1
Higher doses (320 mg or more) have been associated with improved bowel preparation quality and fewer bubbles in a meta-analysis of 38 trials with 10,505 patients 1

A meta-analysis of 38 trials demonstrated that oral simethicone use at doses of 320 mg or higher was associated with improved bowel preparation quality and fewer bubbles 1
In one trial, adding 400 mg of simethicone to the final 500 mL of consumed clear liquid during a 2 L PEG + ascorbate regimen significantly improved the percentage of patients with adequate bowel preparation (BBPS score ≥ 6) from 84% to 99% 1
Another trial showed that adding 1,200 mg of simethicone to a single-dose 2 L PEG regimen improved the percentage of patients with adequate bowel preparation (BBPS score >6) from 76.6% to 88.2% 1

The timing of simethicone administration appears less critical than the dose 1
Studies have shown conflicting results regarding optimal timing:
- One study found no difference in BBPS scores or adenoma detection rate (ADR) whether simethicone was given with the first or second liter of a split-dose preparation 1
- Earlier dosing may be associated with shorter cecal intubation times and higher detection of diminutive right-sided adenomas 1

Adding simethicone to a PEG-based bowel preparation regimen reduces the need for intraprocedural simethicone use from 49% to 2% of colonoscopies 1
While simethicone improves bowel preparation quality and reduces bubbles, it has not consistently been shown to improve overall adenoma detection rates 1
Consider patient cost when adding simethicone to a bowel preparation regimen 1
For standard over-the-counter simethicone (180 mg per softgel), patients would need to take 2 softgels to achieve the recommended minimum dose of 320 mg 2

Low-dose simethicone (200 mg) may be as effective as high-dose (1,200 mg) for adequate bowel preparation when used with split-dose 2 L PEG, with potential advantages for intubation time and right colon visualization 3
When using simethicone for colonoscopy preparation, the dose exceeds the standard over-the-counter recommendation (which is 1-2 softgels or 180-360 mg per 24 hours) 2